GAINESVILLE, Fla. (AP) — Advice from the nation’s top disease control experts on how to safely reopen businesses and institutions in the midst of the coronavirus pandemic included detailed instructive guidance and some more restrictive measures than the plan released by the White House last month. The guidance, which was shelved by Trump administration officials, also offered recommendations to help communities decide when to shut facilities down again during future flareups of COVID-19.
The Associated Press obtained a 63-page document that is more detailed than other, previously reported segments of the shelved guidance from the U.S. Centers for Disease Control and Prevention. It shows how the thinking of the CDC infection control experts differs from those in the White House managing the pandemic response.
The White House’s “Opening Up America Again” plan that was released April 17 included some of the CDC’s approach, but made clear that the onus for reopening decisions was solely on state governors and local officials.
By contrast, the organizational tool created by the CDC advocates for a coordinated national response to give community leaders step-by-step instructions to “help Americans re-enter civic life,” with the idea that there would be resurgences of the virus and lots of customization needed. The White House said last week that the document was a draft and not ready for release.
It contains the kinds of specifics that officials need to make informed decisions, some experts said.
“The White House is pushing for reopening but the truth of the matter is the White House has just not had a comprehensive plan where all the pieces fit. They’re doing it piecemeal,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
Such detailed advice should have been available much earlier, said Stephen Morse, a Columbia University expert on the spread of diseases.
“Many different places are considering how to safely develop return-to-work procedures. Having more guidance on that earlier on might have been more reassuring to people. And it might have have prevented some cases,” Morse said.
From the start, CDC staffers working on the guidance were uncomfortable tying it specifically to reopening, and voiced their objections to the White House officials tasked with approving the guidance for release, according to a CDC official granted anonymity because they were not cleared to speak with the press.
The CDC’s detailed guidance was eventually shelved by the administrationApril 30, according to internal government emails and CDC sources who were granted anonymity because they were not cleared to speak to the press. After The AP reported about the burying of the guidance last week, the White House asked the CDC to revive parts of it, which were sent back for approval, according to emails and interviews.
On Tuesday, CDC Director Robert Redfield testified before a U.S. Senate committee that the recommendations would be released “soon.” He provided no further details. Internal government emails show that Redfield had repeatedly sought White House approval for CDC’s guidance, starting as early as April 10.
Both the CDC document and the White House’s published plan recommend communities reopen in phases as local cases of coronavirus subside.
One of many differences, however, is advice for when communities should allow for the resumption of nonessential travel.
The shelved CDC guide advises communities to avoid all nonessential travel in phases of reopening until the last one, when cases are at the lowest levels. Even then, the CDC is cautious and advises only a “consideration” of the resumption of nonessential travel after 42 continuous days of declining cases of COVID-19.
The White House plan, by contrast, recommends that communities “minimize” travel in Phase 1, and that in Phase 2, after 28 consecutive days of decline, “Non-essential travel can resume.”
As of Tuesday, CDC’s web page on travel guidance during the pandemic still linked to the White House plan. The stricter guidance is not there.
Another stark difference in the final White House plan and that designed by epidemiologists at the CDC is the latter’s acknowledgement that COVID-19 cases will likely surge after states reopen, and that local governments need to continuously monitor their communities closely.
The White House’s final reopening plan lacks guidance on how local communities can track information beyond positive cases. But the CDC document offers thoughts on how to plan for where case increases might occur more quickly, using demographic information. The CDC says local leaders could take special notice of the number of households with limited English literacy in an area, how many people live in poverty or have no health insurance coverage, and even what it calls areas of “civic strain” caused by the virus, such as places where many workers were sick or lost wages due to shutdowns.
The White House plan offers few such specifics and instead provides broad guidance, such as “Protect the health and safety of workers in critical industries,” and advises states to “protect the most vulnerable” by developing “appropriate policies.”
On Tuesday, Dr. Anthony Fauci, the nation’s top infectious disease expert, warned that lifting stay-at-home orders too quickly could lead to serious consequences, both in deaths and economic hardship. President Donald Trump, meanwhile, has continued to push states to act to right a free-falling economy.
The CDC’s guidelines stress the dangers of states and regions going it alone in such perilous times. The agency advises a national approach, rather than a patchwork, because policies in one state will in time affect others.
“Travel patterns within and between jurisdictions will impact efforts to reduce community transmission too. Coordination across state and local jurisdictions is critical — especially between jurisdictions with different mitigation needs,” the report states.
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Fauci warns: More death, econ damage if US reopens too fast
WASHINGTON (AP) — The U.S. government’s top infectious disease expert issued a blunt warning Tuesday that cities and states could “turn back the clock” and see more COVID-19 deaths and economic damage alike if they lift coronavirus stay-at-home orders too fast — a sharp contrast as President Donald Trump pushes to right a free-falling economy.
“There is a real risk that you will trigger an outbreak that you may not be able to control,” Dr. Anthony Fauci warned a Senate committee and the nation as more than two dozen states have begun to lift their lockdowns as a first step toward economic recovery.
The advice from Fauci and other key government officials — delivered by dramatic, sometimes awkward teleconference — was at odds with a president who urges on protests of state-ordered restraints and insists that “day after day, we’re making tremendous strides.”
Trump, whose reelection depends to a substantial degree on the economy, talks up his administration’s record with the virus daily.
Underscoring the seriousness of the pandemic that has reached Congress and the White House, Fauci and other experts testified from their homes. Committee Chairman Lamar Alexander chaired the hearing from the study in his cabin in Tennessee, although several committee members attended in person in an eerily empty Capitol Hill chamber, masked and sitting 6 feet apart.
The tension in balancing people’s safety from the virus, which is still surprising doctors with the sneaky ways it can kill, against the severe economic fallout is playing out in many other countries, too. Italy partially lifted lockdown restrictions last week only to see a big jump in confirmed COVID-19 infections in its hardest-hit region. And Lebanon relaxed a national lockdown late last month but said Tuesday the restrictions are being reinstated for the rest of the week after a spike in reported infections.
More infections and deaths are inevitable as people again start gathering, but how prepared communities are to stamp out those sparks will determine how bad the rebound is, Fauci told the Senate Health, Education, Labor and Pensions Committee.
“There is no doubt, even under the best of circumstances, when you pull back on mitigation you will see some cases appear,” Fauci said..
Move too quickly and “the consequences could be really serious,” he added. It not only would cause “some suffering and death that could be avoided, but could even set you back on the road to try to get economic recovery.”
With more than 30 million people unemployed in the U.S., Trump has been pressuring states to reopen.
A recent Associated Press review determined that 17 states did not meet a key White House benchmark for loosening restrictions — a 14-day downward trajectory in new cases or positive test rates. Yet many of those have begun to reopen or are about to do so, including Alabama, Kentucky, Maine, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, Tennessee and Utah.
Of the 33 states that have had a 14-day downward trajectory, 25 are partially opened or moving to reopen within days, the AP analysis found. Other states that have not seen a 14-day decline, remain closed despite meeting some benchmarks.
Fauci expressed optimism that eventually vaccines will arrive, along with treatments in addition to the one drug that so far has shown a modest effect in fighting COVID–19. But it would be “a bridge too far” to expect them in time for fall when schools hope to reopen, he said.
For now, “all roads back to work and back to school go through testing,” said Alexander, the Republican committee chairman.
Although Trump declared this week, “we have met the moment, and we have prevailed” in increasing and improving virus testing, Republican senators on the panel were noticeably less sanguine.
A lack of testing has dogged the U.S. response from the beginning, when a test developed by the Centers for Disease Control and Prevention ran into numerous problems. Utah Sen. Mitt Romney said the U.S. may finally have outpaced testing leader South Korea but that country has far fewer deaths because it started testing early.
“I find our testing record nothing to celebrate whatsoever,” Romney said.
Trump administration “testing czar” Adm. Brett Giroir said the U.S. could be performing at least 40 million to 50 million tests per month by September. That would work out to between 1.3 million to 1.7 million tests per day. Harvard researchers have said the U.S. must be doing 900,000 by this Friday in order to safely reopen.
And a test only tells if someone is infected that day — they could catch the virus the next day. Pushed by Alexander on how the nation’s 100,000 schools and 5,000 colleges could reopen in August, Giroir expressed confidence there would be enough tests for schools to devise safe strategies, perhaps by testing a certain number of students every few days.
Worldwide, the virus has infected nearly 4.2 million people and killed over 287,000 — more than 80,000 deaths in U.S. alone, the world’s highest toll. Fauci said U.S. deaths likely are higher than the official count.
While Fauci has become the trusted science voice for millions of Americans, Sen. Rand Paul expressed frustration with his cautions. The Kentucky Republican said Fauci was not the “end all” in knowledge about the coronavirus and it’s “kind of ridiculous” to suggest children shouldn’t go back to school — something Fauci never said.
“We don’t know everything about this virus and we really better be pretty careful, particularly when it comes to children,” Fauci said.
While children do seem less susceptible, doctors in New York are investigating about 100 youngsters whose COVID-19 may be linked to a rare and dangerous inflammatory reaction. Three have died.
COVID-19 is devastating nursing homes as well, with infections and deaths soaring among residents and their caregivers.
“If we are able to get masks to everybody in the White House, I hope we can get masks to every nursing home employee who needs it,” said Sen. Maggie Hassan, D-N.H., who also asked why those vulnerable populations were having a hard time getting tested when employees in contact with Trump get a daily test.
The White House recently recommended that states test all nursing home residents and staff within the next two weeks.
Sen. Chris Murphy, D-Conn., blasted the Trump administration for “criminally vague” guidance on how states can safely reopen their economies. He pressed CDC Director Robert Redfield on why detailed recommendations prepared by agency experts had been shelved, as reported by The Associated Press. Redfield replied that those recommendations should appear on the agency’s website soon.
Three of Tuesday’s experts, Fauci, Redfield and Food and Drug Administration Commissioner Stephen Hahn, are in “modified quarantine” after two White House staffers recently became infected but they’re allowed to attend critical administration meetings, masked and keeping their distance.
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